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ACOG Perinatal Care Guideline Summary 7th
ACOG Perinatal Care Guideline Summary 7th
Prenatal Care:
The current American Congress of Obstetricians and Gynecologists (ACOG) Guidelines for Perinatal Care, Seventh Edition
October 2012 is available at http://www.acog.org/resources_and_publications/ 1
The following reference is a summary of the key clinical indicators of the guideline.
Office visits
Frequency:
o Advise office visit at 8-10 weeks of pregnancy (or earlier if the patient is at risk for ectopic pregnancy)
o Every 4 weeks for first 28 weeks.
o Every 2 – 3 weeks until 36 weeks gestation.
o Every week after 36 weeks gestation.
Frequency of visits is determined by individual needs and assessed risk factors.
Goal: Coordination of care for detected medical and psychosocial risk factors.
• Genetic history.
• Discuss genetic counseling and available prenatal diagnostic testing (invasive and non-invasive).
• Education regarding: Labor and delivery, nutrition, exercise, working, air travel, routine dental care, tobacco use
and smoke exposure, alcohol/drug consumption, over-the-counter medications, pets, etc.
• Practices to promote health maintenance such as use of safety restraints including lap and shoulder belts.
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SUMMARY OF ACOG GUIDELINES FOR PERINATAL CARE
Recent research by the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) has suggested that using a one-step
screening method, instead of the two-step method described above, results in more accurate identification of women
with GDM. The study also emphasized that universal screening is the best method to improve diagnosis results.
TheInternational Association of Diabetes and Pregnancy Study Groups (IADPSG) and the American Diabetes Association
(ADA) are currently working with U.S. obstetrical organizations to consider adopting diagnostic criteria recommended by
the HAPO study. A diagnosis of “Overt Diabetes” is also under consideration for high risk women who meet the criteria
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SUMMARY OF ACOG GUIDELINES FOR PERINATAL CARE
for GDM prior to 24 weeks gestation. ACOG currently does not endorse a change to a one-step screening for gestational
diabetes.
Subsequent Prenatal Visits
Every visit
• Vital signs.
11 – 14 weeks
• Pelvic exam if fetal heart tones (FHT) not heard with amplification.
• Breastfeeding has well documented short- and long-term medical and neurodevelopmental advantages for
infants. As such, breastfeeding should be strongly encouraged during prenatal care as the best choice for feeding.
Patients should be offered breastfeeding educational material and classes during pregnancy and provided
resources for assistance after delivery. 22
• Review laboratory data. Offer iron supplementation for patients with anemia.
5,9
• Offer screening tests for aneuploidy.
o All pregnant women, regardless of age, should be counseled about non-invasive and invasive prenatal
diagnostic testing for aneuploidy with a discussion of the risks and benefits of each.
o Women found to have increased risk for aneuploidy with non-invasive screening should be offered genetic
counseling and the option of chorionic villus sampling (CVS) or second trimester amniocentesis
• If previous low transverse cesarean delivery, discuss the risks, benefits, and alternatives to a trial of labor after
cesarean as well as the risks and benefits of repeat cesarean delivery.
o In the absence of medical indications, labor should not be induced prior to 39 weeks gestation. Such early-term
deliveries (37-38 6/7 weeks gestation) are associated with higher morbidity and mortality rates when
compared to neonates and infants delivered between 39 weeks and 40 weeks of gestation. 23
15-20 weeks
• Offer anatomic survey ultrasound to be completed at 18-20 weeks.
• Offer screening test for aneuploidy with a serum Multiple Marker Screen if the patient did not have first trimester
screening (invasive or non-invasive) for aneuploidy. This also incorporates neural tube defect (NTD) screening. 5,9
o Screening and invasive diagnostic testing for aneuploidy should be available to all women who present for
prenatal care before 20 weeks of gestation regardless of maternal age.
o Offer genetic counseling and the option of second trimester amniocentesis to women found to have increased
risk for aneuploidy with screening.
• Offer neural tube defect screening (MSAFP) to women who elect first trimester screening or invasive testing for
aneuploidy.
• Review signs and symptoms of pre-term labor (PTL).
• Review results of MSAFP/Multiple Marker screen and ultrasound if not already done.
24 – 28 weeks
• Screening for gestational diabetes.
• Select baby’s medical provider.
• Discuss normal fetal movement
• Discuss prenatal classes
• Discuss post-partum contraception. If applicable, patient should sign Medicaid consent for sterilization at this
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SUMMARY OF ACOG GUIDELINES FOR PERINATAL CARE
gestational age.
27-36 weeks
• Tdap should be administered during each pregnancy, irrespective of patient’s prior history of receiving. Optimal
timing is between 27 and 36 weeks gestation to maximize maternal antibody response and passive antibody
transfer levels in the newborn. Discuss with the patient that other adults who will be around her newborn, such as
husbands, grandparents, older siblings, and babysitters, should also be vaccinated. 20,21
28 weeks
• Repeat type and screen if Rh negative, H&H.
• Administer Rh-immune globulin if Rh (-) and indirect Coombs (-).
• Confirm and document name of baby’s medical provider.
• Discuss cord blood banking to allow a pregnant woman to make an informed decision on whether to participate in
a public or private umbilical cord blood banking program. (Per PA House Bill 874).
32 – 34 weeks
• Repeat testing for women at risk for sexually transmitted disease, including RPR, HIV, gonorrhea and chlamydia.
2,15
o Pelvic exam and /or weight, BP, breast, and abdomen exam.
o Screen for postpartum depression. Refer for intervention if indicated.
o Screen for domestic violence.
o Discuss sexual activity and contraception with an emphasis on the benefits of long-acting reversible
contraception.
o Review nutrition and exercise.
o Discuss method of feeding (breast or bottle).
• Women with GDM should be screened for diabetes 6-12 weeks postpartum and should be followed up with
subsequent screening for the development of diabetes or pre-diabetes.7
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Goal: Return to optimal maternal health and recovery post pregnancy
17. Lockwood CJ, Magriples U. Prenatal care (second and third trimesters). UpToDate; Ver. 19.2, updated Aug 1, 2013.
18. Berens P. Overview of postpartum care. UpToDate; Ver 19.2, updated Sep 27, 2013.
19. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR
2010;59 (No. RR-12).
20. Centers for Disease Control and Prevention. Updated Recommendations for Use of Tetanus Toxoid, Reduced
Diphtheria Toxoid and Acellular Pertussis Vaccine (Tdap) in Pregnant Women – Advisory Committee on Immunization
Practices (ACIP), 2012. MMWR 2013;62:131-135.
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21. Update on Immunization and Pregnancy: Tetanus, Diphtheria, and Pertussis Vacination. Committee Opinion No. 566.
American College of Obstetricians and Gynecologists. Obstet Gynecol 2013; 121:1411-4.
22. American Academy of Pediatrics: Breastfeeding and the Use of Human Milk. Pediatrics 2005; 115:2 496-506.
23. American Congress of Obstetricians and Gynecologists, Committee Opinion No. 561. Non-medically indicated early-
term deliveries. Obstet Gynecol 2013; 121:911-5.